Provider Demographics
NPI:1669894598
Name:UDEH-NWOSUOCHA, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:UDEH-NWOSUOCHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4994 HIGHWAY 6 N STE 104D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6902
Mailing Address - Country:US
Mailing Address - Phone:281-861-0088
Mailing Address - Fax:281-856-8997
Practice Address - Street 1:16100 CAIRNWAY DR STE 225
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3500
Practice Address - Country:US
Practice Address - Phone:281-861-0088
Practice Address - Fax:281-856-8997
Is Sole Proprietor?:No
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132883246RM2200X
TX5062246RM2200X
FLTN44801246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory